Intramuscular extended‐release naltrexone: current evidence
Abstract
Extended-release naltrexone (XR-NTX; Vivitrol), developed to address poor adherence in addictive disorders, is approved for use in alcohol and opioid-dependence disorders. In alcohol-dependent adults with ≥ 4-day initial abstinence, XR-NTX increased initial and 6-month abstinence. An fMRI study found that XR-NTX attenuated the salience of alcohol visual and olfactory cues in the absence of alcohol, and post hoc analyses demonstrated efficacy even during high cue-exposure holiday periods. Safety and tolerability have generally been good, without adverse hepatic impact or intractable acute pain management. XR-NTX use appears feasible in primary care and public systems, and retrospective claims analyses have found cost savings and decreased intensive service utilization relative to oral agents. In opioid dependence, following detoxification, XR-NTX shows efficacy for maintaining abstinence, improving retention, decreasing craving, and preventing relapse. Trials are also exploring its use for the treatment of stimulant dependence. XR-NTX appears compatible with counseling and self-help attendance. While more research is needed, current findings suggest that a formulation of naltrexone that was sought beginning over three decades ago is fulfilling its promise as an extended-release pharmacotherapeutic.
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Naltrexone's antagonist effect can be overcome in acute pain, but caution is advised.
“Its antagonist effect can be overridden in setting of acute pain but caution is advised.138”
From Maintenance Medication for Opiate Addiction: The Foundation of Recovery (2012) · cites this paper as [138]
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Krupitsky, E., Nunes, E. V., Ling, W., Illeperuma, A., Gastfriend, D. R., & Silverman, B. L. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60358-9 · Cited by 555 · see citing works
Self-citationMaintenance Medication for Opiate Addiction: The Foundation of Recovery
Bart, G. (2012) · Journal of Addictive Diseases · doi:10.1080/10550887.2012.694598 · Cited by 461 · see citing works
Pharmacotherapy for alcohol dependence: status of current treatments
Franck, J., & Jayaram-Lindström, N. (2013) · Current Opinion in Neurobiology · doi:10.1016/j.conb.2013.05.005 · Cited by 107 · see citing works
Medications for substance use disorders
Douaihy, A. B., Kelly, T. M., & Sullivan, C. (2013) · Social Work in Public Health · doi:10.1080/19371918.2013.759031 · Cited by 93 · see citing works
Lukas, S. E., Lowen, S. B., Lindsey, K. P., Conn, N., Tartarini, W., Rodolico, J., Mallya, G., Palmer, C., & Penetar, D. M. (2013) · NeuroImage · doi:10.1016/j.neuroimage.2013.03.055 · Cited by 83 · see citing works
- Authors
- Gastfriend, D. R.
- Affiliations
- Alkermes (United States) (US)
- Corresponding author
- Gastfriend, David R.
- ORCID
- Gastfriend, David R.
- Venue
- Annals of the New York Academy of Sciences
- Publisher
- Wiley
- Published
- 2011-01
- Volume
- 1216
- Issue
- 1
- Pages
- 144-166
- ISSN
- 0077-8923 (ISSN-L)
- 1749-6632
- OpenAlex
- W1940404040
- Cited by
- 71
- References
- 108
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 3 · 2022: 1 · 2021: 1 · 2019: 2 · 2018: 5 · 2017: 8 · 2016: 8 · 2015: 11 · 2014: 6 · 2013: 8 · 2012: 9
- FWCI
- 1.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of the New York Academy of Sciences (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Keywords
- extended-release naltrexone, Vivitrol, alcoholism, opioid use disorder, stimulant use disorder, pharmacotherapy, medication adherence, abstinence, cue exposure, relapse prevention, craving, treatment retention, cost reduction, primary care
- MeSH terms
- Alcohol Drinking, Alcoholism, Delayed-Action Preparations, Humans, Injections, Intramuscular, Naltrexone, Narcotic Antagonists, Opioid-Related Disorders, Alcohol-Related Disorders
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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